Anorexia Nervosa

                                                   Anorexia Nervosa

  An eating disorder causing people to obsess about weight and what they eat.

Anorexia Nervosa is a serious, potentially life-threatening eating disorder characterized by self-starvation and excessive weight loss. 

 The condition commonly involves emotional challenges, an unrealistic body image, and an exaggerated fear of becoming overweight or obese. If often begins during the teenage years or early adulthood, but it can begin in the preteen years. It is the third most common chronic illness among teens. 

  Eating disorders affect some 30 million men and women in the United States. Both men and women can develop anorexia, but it is 10 times more common in females. Nearly 1 in every 100 American women will experience anorexia some time. Anorexia nervosa is different from anorexia, which means a loss of appetite or inability to eat. 

Fast facts on Anorexia Nervosa:

  Here are some key points about anorexia nervosa
. Anorexia nervosa is a psychological condition that involves an eating disorder. 
. Symptoms include a very low body mass index, a refusal to eat, and attempts to lose weight, even when body mass index is very low. 
. It is thought to be triggered by a combination of biological, environmental, and genetic factors. 
. Treatment can take some time, but with a combination of counseling and other types of therapy, recovery is possible. 

Anorexia nervosa is a psychological condition and an eating disorder in which the individual loses more weight than is healthy for their height and age. The individual will maintain a body weight of 85% or less of their expected weight. 

. A person with anorexia will internationally restrict their food intake, generally due to a fear of being or becoming fat, even when their body mass index is already low. They may also practice excessive, use laxatives, and vomit to reduce weight, but to a lesser extent then those diagnosed with bulimia. 

.Complication can be severe. An eating disorder is reported t have the highest mortality rate of any mental illness. Treatment includes hospitalization and counseling. 

Symptoms:

 Anorexia nervosa is a complex condition, but the main sign is usually severe weight loss. The person may also talk about being overweight, although objective measures, such as BMI, show that this is not true.
 Behavioral changes may include a refusal to eat, exercising excessively, and use of laxatives or vomiting after consuming food. 

- Severe loss of muscle mass

- Hypotension, or blood pressure

- Listlessness, fatigue, exhaustion 

- Lightheadedness or dizziness 

- Hypothermia, or low body temperature, and cold hands and feet

- Bloated or upset stomach and constipation

- Dry skin

- Alopecia, or hair loss

- Swollen hands and feet

- Infertility 

- Insomnia 

- Loss of menstruation or less frequent periods

- Brittle nails

- Osteoporosis, or loss of bone density

- Irregular or abnormal heart rhythms

- Lanugo, fine downy hair growing all over the body, and increased facial hair signs of vomiting include bad breath and tooth decay, due to the acid in the vomit. 

Psychological signs and symptoms include:

- Obsession with food, for examples, reading cookery books
- Excessive concern about being fat or overweight 
- Frequently measuring and weighing themselves and inspecting their bodies in the mirror
- Lying about food intake
- Not eating or refusing to eat
- Reduce sex drive 
- Self- denial
- Lack of emotion or a depressed mood 
- Over-exercising
- Irritability
- Memory loss
- Obsessive-compulsive behavior 
Food and eating become associated with guilt. It may be difficult to talk to the person about a possible problem, as they will likely refuse to acknowledge that anything is wrong. 

Causes:

 No single cause has been identified for anorexia nervosa. It probably happens as a result of biological, environmental, and psychological factors. 

- Being susceptible to depression and anxiety
- Having difficulty handling stress. 
- Being excessively worried, afraid, or doubtful about the future
- Being perfectionist and overly concerned about rules. 
- Having a negative self-image
- Having eating problems during early childhood or infancy
- Having had an anxiety disorder during childhood. 
- Holding specific regarding beauty and health, which may be influenced by culture or society
- Having a high level of emotional restraint or control over their own behavior and expression, the person may be overly worried about their weight and shape, but this is not necessarily the key factor. 

  33 and 50 % of people with anorexia also have a mood disorder, such as depression, and around half have an anxiety disorder, such as Obsessive-compulsive disorder and social phobia. This suggests that negative emotions and a low self-image may contribute, in some cases. A person may develop anorexia Nervosa as a way of gaining control of some of their life. As they exert control of their food intake, this feels like success, and so the behavior continues. 

Environmental factors:

 Environmental factors may include the hormonal changes that occur during puberty, plus feelings of anxiety, stress, and low self-esteem. The fashion industry and media messages suggesting that being thin is beautiful may have an impact. 
- Physical, sexual, emotional or other types of abuse
- Family or other relationship problems
- Being bullied
- Fear and pressure to succeed 
- A stressful life event, such as bereavement or becoming unemployed.

Genetic Factors:

 Studies have found that some people with eating disorders may have an imbalance in certain brain chemicals that control digestion, appetite, and hunger. Further research is needed to confirm this. Genetic factors may affect a person's susceptibility to eating disorders, as they can run in families. between 50 to 80% of the risk for anorexia is thought to be genetic.  

Vicious cycle:

Once a person starts losing weight, low weight and lack of nutrients may contribute to brain changes in a way that reinforces the behaviors and obsessive thoughts related to anorexia nervosa. The changes could involve the part of the brain that controls appetite, 

Once a person starts losing weight, low weight and lack of nutrients may contribute to brain changes in a way that reinforces the behaviors and obsessive thoughts related to anorexia nervosa. 

The changes could involve the part of the brain that controls appetite or they could increase the feelings of anxiety and guilt that become associated with eating. 

  Anorexia nervosa may have different gut microbial communities than those without the condition. The authors suggested that this could contribute to anxiety, depression, and further weight loss. People with anorexia nervosa are less able to differentiate between different types of positive emotion. This can lead to further weight-loss behavior, as self- deprivation becomes associated with a sense of pride. 

Diagnosis:

 Diagnosis and prompt treatment increase the chance of a good outcome. 

   The physician will ask the patient about weight loss, how they feel about their weight, and, for females, about menstruation. It can be hard fo the patient to open up and speak frankly about themselves. It can take years to confirm a diagnosis, especially if the person was previously obese. If the physician detects signs of anorexia nervosa, they may order tests to rule out other underlying medical conditions with similar signs and symptoms. 
- Diabetes, Addison's disease
- Chronic infections, Malabsorption
- Immunodeficiency, Cancer
- Inflammatory bowel disease, Hyperthyroidism 

Complications: 

 Complications can affect every body system, and they can be severe. 

Physical complications include: 

- Cardiovascular problems: These include low heart rate, low blood pressure, and damage to the heart muscle. 

- Blood problems: There is a higher risk of developing leukopenia, or low white blood cell count. and anemia, a low red blood cell count. 

Gastrointestinal problems: Movement in the intestines slow significantly when a person is severely underweight and eating too little, but this resolves when the diet improves. 

 Kidney problems: Dehydration can lead to highly concentrated urine and more urine production. The kidneys usually recover as weight levels improve. 

Hormonal problems: Lower levels of growth hormones may lead to delayed growth during adolescence. 

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Vitiligo, Vitiligo is a blessing in disguise!!!

                                                                Vitiligo

   Vitiligo is a disease that causes the loss of skin in blotches. The extent and rate of color loss from vitiligo are unpredictable. It can affect the skin on any part of your body. It may also affect the hair and the inside of the mouth. 

    Vitiligo is a skin disorder in which the cells that make melanin pigments are destroyed. The destruction results in the appearance of white patches o the skin. Vitiligo can occur at any age, but usually before the age of 20 in about 50 % of patients.  

    Normally, the color of hair and skin is determined by melanin. Vitiligo occurs when the cells that produce melanin die or stop functioning. Vitiligo affects people of all skin types, but it may be more noticeable in people with darker skin. The condition is not life-threatening or contagious. It can be stressful or make you feel bad about yourself. 

     There are five main types of vitiligo, which are based upon the location of the white patches and the pattern of involvement, focal, generalized, acrofacial, segmental and universal.

  Focal vitiligo: minimal involvement with only one or a very few white patches scattered on the skin.

Generalized Vitiligo: The most common type with symmetrical patches on any location on the skin including the trunk and or extremities. 

Acrofacial Vitiligo: White patches limited to the fingers and around the mouth and eyes.

Segmental Vitiligo: White patches on one side of the body and in a linear or line like distribution.

Universal Vitiligo: Widespread patches involving the entire body.  

    The cause of vitiligo is not well understood. It is believed to be an autoimmune, disorder which means that certain blood cells in your body, lymphocytes, turn against and attack the melanocytes. Another theory is that vitiligo is caused by an interaction between the body nerve cells and melanocytes. 

    Vitiligo may be associated with other immune disorders. They include Addison disease, alopecia areata, diabetes mellitus, thyroid disease, melanoma, chronic mucocutaneous candidiasis, pernicious anemia, and uveitis. 

   Skin is made up of many layers, the skin is the largest organ of the body. It protects, maintains the temperature balance, releases out the toxins out of the body in the form of sweat and maintains the equilibrium. It reflects the internal and general health of the person. Unhealthy, dry, discolored and pigmented skin depicts indication for certain medical diseases.

  Skin cell contains melanin, a dark pigments that give the color to the skin and protects it from the strong rays of the sun that are particularly harmful. If the melanin is destroyed at a certain part of the body or not produced then the skin looses, its color and turns leave white spots known as Leukoderma or Phulveri in laymen's language. Leukoderma means Leuco- white and derma, the skin is also known as vitiligo in medical terminology. It is also true that all white spots are not of leukoderma. 

 Children born with congenital absence of melanin have complete white skin of the whole body called Albinism that is a congenital and incurable condition. 

Symptoms:

 The main sign of vitiligo is patchy loss of skin color. Usually, the discoloration first shows on sun-exposed areas, such as the hands, feet, arms, face, and lips. 

Vitiligo signs include:

  . Patchy loss of skin color
  . Premature whitening or graying of the hair on your scalp, eyelashes, eyebrows or beard.
  . Loss of color in the tissues that line the inside of your mouth and nose 
  . Loss of or change in color of the inner layer of the eyeball 
  
Vitiligo can start at any age, but often appears before age 20 

Depending on the type of vitiligo you have, the discolored patches may cover;

Many parts of your body. with the most common type, called generalized vitiligo, the discolored patches often progress similarly on corresponding body parts

Only one side or part of your body. This type, called segmental vitiligo, tends to occur at a younger age, progress for a year or two, then stop. 

One of only a few areas of your body. This type is called localized vitiligo. 

   It's difficult to predict how your disease will progress. Sometimes the patches stop forming without treatment. In most cases, pigment loss spreads and eventually involves most of your skin. Rarely, the skin gets its color back. 

Aetiology:

 Vitiligo is obscure, the various hypothesis is suggestive of its genesis. Among these the important ones are   

. Immune Hypothesis:
    Melanocyte destruction and dysfunction or both may result in Hypopigmentation of vitiligo. 

. Neural Hypothesis:
    Neurochemical inhibitors are released at nerve endings that destroy the melanocytes or inhibit their functioning. 

. Melanocyte self- Destruction Hypothesis:
    Proposes that an intermediate in melanin synthesis causes melanocyte destruction. 

.Dietary deficiency of proteins and cupro minerals is a major factor for causing vitiligo. Serum skin and cerebrospinal fluid copper levels are low in these cases. 

. A gastrointestinal disorder like chronic amoebiasis, chronic dyspepsia, and intestinal worms may be additional factors.  

. Use of broad-spectrum antibiotics, especially chloramphenicol and streptomycin leads to the appearance of vitiligo. 

. Trauma or local irritation caused by wearing the sari or trousers too tightly do produce vitiligo in individuals predisposed to it. 

. Acute stress may be followed by a fast-spreading type of vitiligo proving the theory of Troponeurosis. The emotional crisis may be an additional factor. 

. An Endocrinal disorder may be operative, Diabetes, Pernicious anemia, Thyrotoxicosis, Myxoedema, and Addison's disease may be associated with vitiligo. 

. Composite Hypothesis- None of the theories alone is entirely satisfactory. The actual mechanism of inhibition or destruction of melanocytes is much more complex than any of these mechanisms suggested.  

Precipitating Factors:

. Emotional crisis- Death in the family, loss of a job, sudden shock
. Gastrointestinal tract disorders like worms, Jaundice, amoebiasis. 
. Prolonged use of drugs, antibiotics, oral ovulating agents
. Local causes like trauma burns exposure to chemicals etc. 
. pathologically: A defect in enzyme Tyrosinase is held responsible for vitiligo. According to some dermatologists, it is a Trophoneurosis and melatonin, a substance secreted at nerve endings inhibits Tyrosinase, thus interfering in pigment formation. 

Clinical Presentation of Vitiligo: 

 Localized type:

Focal- one or more macules in two single areas but not segmented. 
Segmental- One or more macules in a dematomal pattern. 
Mucosal- Involvement of mucous membranes alone. 

Generalized Type:

 Acrofacial- Involvement of face and distal extremities
Vulgaris- Scattered macules in symmetrical or asymmetrical distribution. 
Universalis- Total or nearly whole body involvement

Precautions:

 There are certain precautions, which can delay or stop the onset of the disease. 

- Maintain good general disease
- It is a non- communicable disease
- Any patch should be thoroughly examined first
- Application of any unconfirmed tropical medication on the skin should be avoided
- Use of synthetic clothes should be restricted
- Avoid excess intake of sour things
- Avoid steroids 
- It is a myth that leukoderma occurs by drinking milk over the fish. Thre is no relevance in avoiding anything to eat or drink which is white in color as assumed by some people similarly in cases of jaundice for yellow-colored things. 

Homeopathy:

  Offers a comprehensive treatment as it goes to the root of the problem by helping build up immunity and eventually restores the pigmented patches back to the normal skin color. I have observed in the clinic that there is some definite connection in the patents who are being treated for Hypothyroidism then getting Hypertjyroidism show patches of leukoderma as drugs induced leukoderma. 

Miasmatically:

- Syphilitic- Destruction of melanocytes- the predominance
- Psoric - Though in Aphorism 195, Dr. Hahnemann states that in chronic local maladies that are not obviously venereal, the internal antipsoric treatment alone requisite suggests that it is Psoric in nature. 
- Sycotic- As sycosis is the miasm which disturbs the pigment metabolism and produces hyperpigmentation and depigmentation in patches or diffuses in different parts. 

How effective is Homeopathy?

 Homeopathy is able to give wonderful and miraculous cures in many of vitiligo. This is due to the fact that homeopathy treatment enhances the natural production of pigments. According to Homeopathic philosophy vitiligo not a disease in itself but an expression of an inner disturbed state of the body. Thus, the cure should occur at a level where things have gone wrong. In order to archive this, the patient is analyzed on various aspects of mental and physical and familial attributes and also a complete study is done on the psychological environment that the patent has gone through in his life. 

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Stretch marks

                                      Stretch marks

    The medical for stretch marks is "Oestriae atrophic" which tabor's medical dictionary describes as fie pinkish- white or gry lines, usually 14cm in length, seen in part of the body where the skin has been stretched. Commonly seen on thighs, abdomen, and breasts of women who are or have been pregnant, in persons whose skin has been stretch by obesity, tumor, or dropsy, or in persons who have taken for a prolonged period. 

     This is different from cellulite, which is a dimpling of the skin caused by a thin upper layer of the skin with large, irregular fat cells below. Stretch marks are, however, somewhat related to cellulite in that women are much more susceptible than men due to skin anatomy. Women have more subcutaneous fat, which has less of a cohesive cellular structure and also tend to have a thinner top layer of skin which makes the superficial skin more to damage of all kinds. 

     The top layer of skin and the underlying fatty layer are constructed mostly of fats. Besides eating good fats to preserve skin integrity, use plenty of Vitamin C. Vitamin C is the primary nutrient in connective tissue repair. Skin is the largest and thinnest connective tissue organ of the body and uses a high percentage of the available vitamin c for upkeep and repair. Vitamin C is very safe in doses high enough to cause loose stool, at the point you're wasting nutrients, so cut back to a dose that normalizes the stool. This is called taking vitamin C to bowel tolerance fats would be ideally from fresh-baked, broiled or steamed fish, or plant sources such as olive, flax, and safflower. Avoid margarine, fatty meats including lunch meats and canola oil. Avoid mass-produced baked goods, which tend to use poor quality fats.   

  The best approach to stretch marks is, of course, prevention. Keep in mind that skin quality is at least 50 percent genetics, and some women are more prone to stretch marks just because of hard-wired information inherited from parents and grandparents. If your family history points to a greater possibility for stretch marks, you should apply the prevention tactics described below as faithfully as possible.  

    As with all prevention approaches to optimal health, good food is critical. Minimize red meat and other saturated fats, avoid caffeine and excessive alcohol, get lots of greens and fresh fruits, plenty of pure water, and of course, regular moderate exercise. Balancing work with play is essential. Don't forget to sleep. America's most ignored vital nutrient. Please don't skimp on sleep. The best approach to stretch marks is, of course, prevention. Keep in mind that skin quality is at least 50 % genetics and some women are more prone to stretch marks just because of hard-wired information inherited from parent and grandparents. If your family history points to a greater possibility for stretch marks, you should apply the prevention tactics described below as faithfully as possible. 

  As with all prevention approaches to optimal health, good food is critical. Minimize red meat and other saturated fats, avoid caffeine and excessive alcohol, get lots of greens and fresh fruits, plenty of pure water, and of course, regular moderate exercise. Balancing work with play is essential. Don't forget sleep, America's most ignored vital nutrient. Don't skimp sleep.  

Skin Brushing : 

  Daily brushing of the entire skin surface with a stiffy, dry, skin brush is a Scandinavian beauty secret. Skin brushing takes off the top layer of dead cells. First thing in the morning, firmly stroke the brush over the skin towards the heart. Start with the feet, moving up the legs, be extra firm around the thighs and buttocks. Gentler on the belly, move in a clockwise direction as you look down at your navel, this is the direction which waste travels out of your body in the colon. Use the long handle to get the whole back. Gently up under the breasts and down the neck and throat. Go up the arms starting from the hands. with time, the skin becomes healthier and much less susceptible to irreversible stretching. 

Contrast Hydrotherapy:
   
  The alternating application of hot and cold water to the skin is a fundamental health tool for naturopathic doctors and, hopefully, their patients. Hot water encourages blood flow to the skin, cold contracts the tiny vessels, pushing excess fluid or debris into the natural garbage collection system of the body, the lymphatic channels. The basic approach to contrast hydrotherapy is bathing in warm or hot water, then chasing with cold. Ideally, the temperature differential would be at least 60 degrees F. The treatment must end with cold water, and kames sure to get under the armpit and the groin area. Also, turn around to reach to kidneys which are protected by the lower ribs in back, to encourage waste elimination. 

Not losing or gaining weight quickly:

  This is usually the reason stretch marks occur. You can improve the elasticity of the skin with a good diet, vitamin C, vitamin E and the skincare measures described above, but preventing skin stretching is best. Pregnant women should be prepared to gain 25 to 40 pounds slowly and steadily and take a full 9 months to regain their pre-pregnancy weight. Crash diets are notoriously bad for the skin and they don't work for permanent weight loss either. 

Vitamin E topically and by mouth:

  Personally, attribute getting through pregnancy with not a single mark on the belly to high-quality Vitamin E. I slathered it on daily the third trimester, and sporadically before that, from neck to knees, ingested 400IUs of vitamin E daily throughout the pregnancy, always breaking open the gel cap with teeth and letting the oil start to absorb right in my mouth, tossing the empty gel cap. I learned this trick from a nutrition instructor if you can possibly chew your supplements like food, the thousand or nerve receptors in the mouth single the brain what's coming down the pike, and start to prepare the digestive tract with the proper enzymes for optimal digestion and absorption. 
  
Fact on stretch marks:

- Stretch marks are long, narrow streaks or stripes that occur when the skin is stretched too quickly. 
- Pregnancy, puberty, and rapid weight gain call all cause stretch marks.

- There is little medical evidence available confirming the effectiveness of current treatments for stretch marks. 
- Stretch marks often fade over time without treatment and do not pose any serious long- term health risks. 

What are stretch marks??

Stretch marks are scars or disfiguring lesions. They are also called striae, striae distensae, striae atrophicans, and striae gravidarum. 

The most common areas affected include:

- Abdomen
- Breasts
- Hips
- Flank
- Buttocks
- Thighs

Stretch marks are not physically dangerous but can cause problems with self-image and anxiety, for some people, stretch marks are a significant cosmetic concern that can affect day-to-day living. 

Signs and symptoms:

 Before stretch marks begin to emerge, the skin can appear thin and pink, it may also feel irritated or itchy. 

The marks initially develop as wrinkly, raised streaks that can be red, purple, pink, reddish-brown or dark brown, depending on skin color. The streaks eventually fade and flatten and tend to change to a silvery color over time. 

Causes and risk factors:

 Extreme skin growth or shrinkage can cause stretch marks, common causes of skin stretching include:

- Pregnancy: Between 50 and 90 % of women who are pregnant experience stretch marks during or after birth. 

- Puberty: Rapid growth is typical in young people going through puberty. This can lead to stretch marks. 

- Rapid weight gain: Putting on a lot of weight in a short of time can cause stretch marks. 

- Medical conditions: Certain conditions can cause stretch marks, such as Marfan the skin tissue, and Cushing's syndrome can lead the body to produce too much of a hormone that leads to rapid weight gain and skin fragility. 

- Corticosteroid use: Prolonged use of corticosteroid creams and lotions can decrease levels of collagen in the skin. Collagen strengthens and supports the skin, and a reduced amount can increase the risk of stretch marks. 

 The skin consists of three key layers. Stretch marks form in the dermis, or middle layer, when the connective tissue is stretched beyond the limits of its elasticity. This is normally due to rapid expansion or contraction of the skin. 

 As the body grows, the connecting fibers in the dermis slowly stretch to accommodate alow growth. However, rapid growth leads to sudden stretching. This causes the dermis to tear, allowing deeper layers of skin to show through. 

This can form stretch marks and contributes to the way they look. 

 Stretch marks eventually fade to a silvery, white, or glossy appearance, due to the pale fat beneath the skin becoming visible instead of the usual blood vessels. 

They are more likely to develop and become more severe where there are high levels of circulating cortisone, or when cortisone is applied to the skin. Cortisol, the stress hormone produced by the adrenal glands, is converted into cortisone. This weakness elastic fibers in the skin.  

Risk factors:

 A number of risk factors have been associated with the development of stretch marks, but the evidence varies. More research is needed to confirm the causes of stretch marks. 

The risk factors for developing stretch marks could be linked to:

- Family history
- Chronic diseases
-  Body mass index (BMI) before pregnant 
- Birthweight of the child in women who are pregnant

   These finding can be explained by the greater degrees of skin stretching in obese women with larger babies and by age-related changes in skin collagen and connective tissue that affect the likelihood of tearing. 

Diagnosis:

 Stretch marks are easily diagnosis based on a skin examination and a review of a person's medical history. 

The doctor will usually ask questions based on signs and symptoms, as well as any medications currently being used or existing medical conditions. 

Stretch marks are not harmful and do not cause medical problems. In rare cases, they may indicate an underlying medical issue that requires treatment or monitoring. 

Prevention:

 Stretch marks cannot always be prevented. However, the following steps may help to reduce the risk: 

- Maintain a healthy weight
- Avoid yo-yo dieting
- Eat a balanced diet rich in vitamin and minerals. Consuming a suitable amount of vitamin A and C can help support the skin, as well as the minerals zinc and silicon. 
- Aim for slow and gradual weight gain during pregnancy.
- Drink six to eight glasses of water every day. 

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Shaken Baby Syndrome

                                  Shaken Baby Syndrome

  Shaken baby syndrome (Shaken impact syndrome) is a serious form of abuse inflicted upon a child. It usually occurs when a parent or other caregiver has shaken a baby out of anger or frustration, often the baby will not cry. 

  Babies have very weak neck muscles that cannot fully support their proportionately large heads. Severe shaking causes the baby's head to move violently back and forth, resulting in serious and somethings fatal brain injury. These forces are exaggerated if the shaking is interrupted by the baby's head hitting a surface. 

  Is a serious brain injury caused by forcefully and violently shaking a baby? Other names for this condition include abusive head trauma, shaken impact syndrome, and whiplash shaken syndrome. it can result from as little as five seconds of shaking. 

  Babies have soft brains and weak neck muscles. They also have delicate blood vessels. Shaking a baby or young child can cause their brain to repeatedly hit the inside of the skull. this impact can trigger bruising in the brain, bleeding in the brain, and brain swelling. Other injuries may include broken bones as well as damage to the baby's eyes, spine, and neck. 

  The shaken baby syndrome is common in children under age 2, but it can affect children up to ae 5. Most cases of shaken baby syndrome occur among infants that are 6 to 8 weeks old, which is when babies tend to cry the most. Playful interaction with an infant, such as bouncing the baby on the lap or tossing the baby up in the air, won't cause the injuries associated with the shaken baby syndrome. Instead, these injuries often happen when someone shakes the baby out of frustration or anger. 

Symptoms of Shaken baby syndrome:

 Symptoms include:

. Difficulty staying awake
. Body tremors
. Trouble breathing
. Poor eating
. Vomiting
. Discolored skin
. Seizures
. Coma
. Paralysis

Deceleration of the head when it impacts a surface can cause the following:

 Subdural hematoma, which is a collection of fo blood between the surface of the brain and the dura.
 This occurs when the veins that bridge from the brain to the dura are stretched beyond their elasticity, causing tears and bleeding. 
 Subarachnoid hemorrhage, which is bleeding between the arachnoid and the brain. 
 Direct trauma to the substance itself, caused when the brain strikes the inner surface of the skull.
 Shearing off or breakage of nerve cell branches in the cortex and deeper structures of the brain caused by violent motion to the brain.  
 Further irreversible damage to the brain substance from the lack of oxygen if the child stops breathing during shaking. 
 Further damage to the brain cells when nerve release chemicals that add to oxygen deprivation to the brain. 

Retinal hemorrhages ranging from a few scattered hemorrhages to extensive hemorrhages involving multiple layers of the retina. 
 Skull fractures resulting from impact when the baby is thrown against a hard or soft surface. 
 Fractures to other bones, including the ribs, collarbone, and limbs, bruising to the face, head and entire body. 

Diagnosis:

 .  Encephalopathy, brain swelling
 . Subdural hemorrhage, or bleeding in the brain
 . Retinal hemorrhage or bleeding in a part of the eye called the retina. 
The doctor will order a variety of tests to check for signs of brain damage and to help confirm the diagnosis. These tests may include: 

. MRI scan, which uses powerful magnets and radio waves to produce detailed images of the brain
. CT scan, which creates clear, cross-sectional images of the brain 
. Skeletal X-ray, which reveals the spine, rib, and skull fractures
. Ophthalmic exam, which checks for eye injuries and bleeding in the eyes

Irreversible brain damage from shaken baby syndrome can occur in a matter of seconds. Many babies experience complications, including:

. Hearing loss
. Seizure disorders
. Development delays 
. Intellectual disabilities
. Cerebral palsy, a disorder that affects muscle coordination and speech

Prevened:

 Shaken Baby Syndrome is preventable. You can avoid harming your baby by not shaking them under any circumstances. It's easy to become frustrated when you can't get your baby to stop crying. However, crying is a normal behavior in infants, and shaking is never the right response. 

   It's important to find ways to relieve your stress when your child cries for extended periods. Calling a family member or a friend for support can help when you feel yourself losing control. Some hospital-based programs can teach you how to respond when infants cry and prevent the injuries associated with the shaken baby syndrome. Make sure your family members and caregivers are also aware of the dangers of shaken baby syndrome.

   Shaken Baby Syndrome is completely preventable. Taking care of a baby can present challenges, especially for first- time parents. However, it is important to remember that it is never acceptable to shake, throw or hit a baby. 




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Parkinson's Disease

                            Parkinson's Disease 

      Parkinson's Disease is a progressive nervous system disorder that affective movement. Symptoms start gradually, sometimes starting with a barely noticeable tremor in just one hand. Tremors are common, but the disorder also commonly causes stiffness or slowing of movement. 

      In the early stages of Parkinson's disease, your face may show little or no expression. Your arms may not swing when you walk. your speech may become soft or slurred, medications might significantly improve your symptoms, occasionally your doctor may suggest surgery to regular certain regions of your brain and improve your symptoms.

  Parkinson's disease signs and symptoms can be different for everyone. Early signs may be mild and go unnoticed. Symptoms often begin on one side of your body and usually remain worse on that side, even after symptoms begin to affect both sides. 

Signs and symptoms:

 Tremor:
  
   A tremor, or shaking, usually begins in a limb, often your hand or fingers. You may a rub your thumb and forefinger back- and - forth, known as a pill-rolling tremor. 

 . Your hand may tremor when it's at rest.

 Slowed movement (bradykinesia):

   Over time, Parkinson's disease may slow your movement, making simple tasks difficult and time- consuming. Your steps may become shorter when you walk. It may be difficult to get out of a chair. You may drag your feet as you try to walk. 

 Rigid muscles: 

   Muscle stiffness may occur in any part of your body. The stiff muscles can be painful and limit your range of motion. 

Tremor:

 A tremor, or shaking, usually in a limb, often your hand or fingers. You may a rub your thumb and forefinger back and forth, known as a pill-rolling tremor. Your hand may tremor when it's at rest. 

Impaired posture and balance:

 Your posture may become stooped, or you may have balance problems as a result of Parkinson's disease. 

 Loss of automatic movements:

  You may have a decreased ability to perform unconscious movements, including blinking, smiling or swinging your arms when you walk. 

Speech changes: 

 you may speak softly, quickly, slur or hesitate before talking. Your speech may be more of a monotone rather than with the usual inflections. 

Writing changes:

 It may become hard to write, and your writing may appear small. 

Causes:

 In Parkinson's disease, certain nerve cells in the brain gradually break down or die. Many of the symptoms are due to a loss of neurons that produce a chemical messenger in your brain called dopamine. When dopamine levels decrease, it causes abnormal brain activity, leading to symptoms of Parkinson's disease. 

The cause of Parkinson's disease is unknown, but several factors appear to play a role, including:

Your Genes:

  Researchers have identified specific genetic mutations that can cause Parkinson's disease. But there are uncommon except in rare cases with many family members affected by Parkinson's disease. However, certain variations appear to increases the risk of Parkinson's disease but with a relatively small risk of Parkinson's for each of these genetic markers. 

Environmental triggers:
  
  Exposure to certain toxins or environmental factors may increase the risk of later Parkinson's disease, but the risk is relatively small. 

  Clumps of specific substances within the brain of people with Parkinson's disease. although it's not clear why these changes occur.

 These changes include: 

The presence of Lewy bodies:

 Clumps of specific substances within brain cells are microscopic markers of Parkinson's disease. These are called Lewy bodies, and researchers believe these Lewy bodies hold an important clue to the cause of Parkinson's disease. 

Alpha-synuclein is found within Lewy bodies: 

    Although many substances are found within Lewy bodies, scientists believe an important one is a natural and widespread protein called alpha-synuclein (a-synuclein). Its' found in all Lewy bodies in a clumped form that cells can't break down. This is currently an important focus on Parkinson's disease researchers.  

Risk Factors: 

 Risk factors for Parkinson's disease include:

 Age: Young adults rarely experience Parkinson's disease. It Ordinarily begins in middle or late life, and the risk increases with age. People usually develop the disease around age 60 or older. 

Heredity: Having a close relative with Parkinson's disease increases the chances that you will develop the disease. However, your risks are still small you many relatives in your family with Parkinson's disease. 

Sex: Men are more likely to develop Parkinson's disease than are women. 

Exposure to toxins: Ongoing exposure to herbicides and pesticides may slightly increase your risk of Parkinson's disease. 

Pathophysiology:

 The main pathological characteristics of PD are cell death in the brain's ganglia and the presence of Lewy bodies in many of the remaining neurons. This loss of neurons is accompanied by the death of astrocytes and a significant increase in the number of microglia in the substantia nigra. 

 There are five major pathways in the brain connecting other brain areas with the basal ganglia. These are known as the motor, oculomotor, associative, limbic and orbitofrontal circuits, with names indicating the main projection area of each circuit. All of them are affected in PD, and their disruption many of the symptoms of the disease, since this circuit has been examined the most intensively. 

Complications: 

Parkinson's disease is often accompanied by these additional problems, which may be treatable:

Thinking difficulties: 

 You may experience cognitive problems and thinking difficulties. These usually occur in the later stages of Parkinson's disease. Such cognitive problems aren't very responsive to medications. 

Depression and emotional changes:

 You may experience depression, sometimes in the very early stages. Receiving treatment for depression can make it easier to handle the other challenges of Parkinson's disease. 
You may also experience other emotional changes, such as fear, anxiety or loss of motivation. Doctors may give you medications to treat these symptoms. 

Swallowing problems:

  You may develop difficulties with swallowing as your condition progresses. Saliva may accumulate in your mouth due to slowed swallowing, leading to drooling. 

Chewing and eating problems. Late-stage Parkinson's disease affects the muscles in your mouth, making chewing difficult. This can lead to choking and poor nutrition. 

Sleep problems and sleep disorders: 

 People with Parkinson's disease often have sleep problems, including waking up frequently throughout the night, waking up early or falling asleep during the day. People may also experience rapid eye movement sleep behavior disorder, which involves acting out your dreams. 

Bladder problems. Parkinson's disease may cause bladder problems, including being unable to control urine or having difficulty urinating. 

Constipation. Many people with Parkinson's disease develop constipation, mainly due to a slower digestive tract. 

Also experience:

 Blood pressure changes: You may feel dizzy or lightheaded when you stand due to a sudden drop in blood pressure.

Smell dysfunction: You may experience problems with your smell. You may have difficulty identifying certain odors or the difference between odors. 

Sexual dysfunction: Some people with Parkinson's disease notice a decrease in sexual desire or performance. 

Fatigue: Many people with Parkinson's disease lose energy and experience fatigue, especially later in the day. The cause isn't always known. 

Pain: Some people with Parkinson's disease experience pain, either in specific areas of their bodies or throughout their bodies. 

Differential Diagnosis:

 . Arthritis
 . Corticobasal syndrome
 . Dementia with Lewy bodies
 . Depression
 . Drug-induced Parkinson's 
 . Huntingtons disease 
 . Idiopathic basal ganglia calcification
 . Fragile X-associated tremor 
 . Multiple system atrophy 
 . Normal-pressure hydrocephalus
 . Obseesional slowness 
 . Toxins
 . Wilson's disease

Prevention :

 Exercise in middle age may reduce the risk of Parkinson's disease later in life. Caffeine also appears protective with a greater decrease in risk occurring with a larger intake of caffeinated beverages such as coffee. People who smoke cigarettes or use smokeless tobacco are less likely than non- smokers to develop PD, and the more they have used tobacco, the less likely they are to develop PD. It is not known to underlie this effect. Tobacco use may actually protect against PD, or it may be that an unknown factor both increases the risk of PD and causes an aversion to tobacco or makes it easier to quit using tobacco. 

 People who smoke cigarettes or use smokeless tobacco are less likely than non-smokers to develop PD, and the more they have used tobacco, the less likely they are to develop PD. It is not known what underlies this effect. Tobacco use may actually protect against PD, or it may be that an unknown factor both increases the risk of PD and causes an aversion to tobacco or makes it easier to quit using tobacco.^[82]

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